0000052359 00000 n Our patch tests also showed some positive reactions to TiO2 (n = 3, 0.9%) in a large group of patients. Some experts believe only 4% of the population suffers from a true titanium allergy. T.R.U.E. �\��`�~{:lHb�n\i��xT�E��P�R褆Offqj�cm���sf�����4��99NȺ �S���f�5��_ ��V� Are allergic reactions to skin clips associated with delayed wound healing? If Ti is a sensitizer, it is probably a weak one, and the fact that the majority of our patients showed mostly + reactions supports this notion. Our study had several limitations. G��i�V�|J�*���{nn��*fe���4-�7� ��������iI\�0k樱����s�l���,d{�/�K�����>��t�pptspstppptppp����}}�}}�}}�YY�YY���eA^�y��g1� �0� �0� �0� ��;�xG�nn�nn�nn�nn�nn�i�`�N F$M���_}�1��8���a�ڠ�/��z�v��0 K �� The significance level for all analyses was P < .05. 0000005944 00000 n 0000010247 00000 n These results support the questionable relevance of positive TiO2 results. 0000002224 00000 n Deze allergie komt vaker voor bij vrouwen dan bij mannen. The frequency of positive results for the tested salts ranged from 0.9% to 7.9%. Given the multifactorial background of the above‐mentioned complaints, other factors, such as aseptic loosening, osteolysis and infection, may also play a significant role.27 Moreover, possible sensitization to other components within the implant makes it complex to determine whether Ti is the primary cause, is an aggravating factor, or is not involved at all in the pathogenesis of the clinical complaints. This is emphasized by the finding of complete or partial relevance in 73.3% of the Ti(IV) oxalate hydrate‐positive subjects in group 1. Of the 26 positive patients, 23 reacted to only one Ti salt; the remaining 3 reacted to two Ti salts. In our clinic, during the past 10 years, different Ti test salts have been applied to evaluate possible sensitization to Ti. MELISA is an optimised, clinically validated blood test which establishes allergy to a number of different metals from a single blood test. Most were orthopaedic and surgical (n = 10) or dental (n = 3), but 1 patient had a neurostimulator and another had an implanted insulin pump. This made statistical analysis for comparison of the groups difficult. We identified erythema, dermatitis (overlying the implant or elsewhere), and local swelling. Notably, no Ti salt was found that was universally positive in patients who had positive test reactions. 10 0 obj <> endobj In one patient (no. 0000036615 00000 n Allergy testing measures the amount of IgE (allergy) antibodies in your blood. A study in Lithuania reported no positive patch test reaction to any of the 5 Ti salts present in their metal series.17 However, only a relatively small number of patients were tested. recommended for use in everyone undergoing patch testing because these include the most common and important allergens that cause dermatitis %PDF-1.3 %���� A patch test‐positive titanium hypersensitivity reaction, Possible allergy to complex titanium salt, Analysis for the potential of polystyrene and TiO2 nanoparticles to induce skin irritation, phototoxicity, and sensitization, Micro analysis of metals in dental restorations as part of a diagnostic approach in metal allergies, https://www.chemotechnique.se/products/products/. 0000007476 00000 n Metal Allergy Patch Test Dental Implants Titanium Allergy Local Lymph Node Assay (LLNA) These keywords were added by machine and not by the authors. However, it should be noted that the patient groups for Ti citrate and Ti lactate were small as compared with those for the other salts. 0000001096 00000 n Few studies to date have profiled titanium allergy, and it therefore remains difficult to distinguish its manifestations. No titanium‐specific risk factors and clinical picture could be identified. Erythema, dermatitis and local swelling were the most common objective complaints. Professor Dr Thomas Rustemeyer, Department of Dermato‐Allergology and Occupational Dermatology, VU University Medical Centre Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Titanium (Ti) is a lustrous transition metal that is widely used as an implant material in medicine and dentistry, and, in its oxide form, as a white pigment in personal care products and food. T.R.U.E. 0000001653 00000 n In addition, this article describes the clinical presentation of Ti‐allergic patients in our clinic. 0000013771 00000 n TiO2 is the most common patch test salt. TEST is sold in boxes of 5 patch test units (5 each of Panel 1.3, 2.3 and 3.3) for patch testing 5 patients. Unfortunately, assessing the accuracy of each of these salts is not within the scope of this study. Titanium impurities Some researchers believe that titanium allergy does not exist and patients are reacting to the impurities in titanium, for … Chromate or titanium allergy—the role of impurities? Ti oxalate may be irritant in nature, owing to the low pH of 2.0‐3.0 when it is exposed to air. Nevertheless, in a summary of TiO2 patch testing reports, Wood et al described 21 patients with positive reactions.9 Unfortunately, no information on clinical relevance was provided. The patient reacted positively to multiple possible components of sunscreens, eg, cosmetic preservatives, wool alcohol, fragrance mix, benzophenone, and Ti. 0000011959 00000 n Titanium dioxide has been found to be an unreliable patch test material. In winkelwagen. In the event that any of these symptoms manifest, patients should immediately undergo allergy testing. Few studies to date have profiled titanium allergy, and it therefore remains difficult to distinguish its manifestations. btw. Thus, results obtained with Ti oxalate should be interpreted with care until results from larger groups of tested patients are available for comparison. In winkelwagen Informatie; Titaanallergie is in beeld te brengen door het aanvragen van de Titaandioxide allergie (BK741) test … Also, the possible referral bias resulting from the selection of patients on the basis of their clinical history has to be taken into account. xref 0000007877 00000 n Patch testing was performed with Van der Bend chambers (van der Bend, Brielle, The Netherlands). IgE antibodies are produced when your body reacts to substances that you might be allergic to, such as specific foods. endstream endobj 11 0 obj <>]/Pages 6 0 R/Type/Catalog/ViewerPreferences<>>> endobj 12 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/TrimBox[0.0 0.0 595.276 841.89]/Type/Page>> endobj 13 0 obj <> endobj 14 0 obj <> endobj 15 0 obj <> endobj 16 0 obj <> endobj 17 0 obj <> endobj 18 0 obj <> endobj 19 0 obj [43 0 R] endobj 20 0 obj <>stream Working off-campus? 0.04% pet., 0.08% pet., 0.16% pet., 0.24% pet. Although we describe relevance in 61.5%, it was difficult to determine whether a positive reaction was putatively responsible for the clinical complaints. Determining the relevance of a positive test reaction in these patients is a challenge. The relevance was categorized as complete, partial, past, no and unknown relevance.15 Evaluations were performed by an experienced dermatologist. startxref A total of 458 patients were tested with ≥1 Ti salts (see Table S1 for combinations and numbers). �gB�9y The following conclusions were obta … been developed, ... [Show full abstract] titanium allergy and to find out the alternative biomaterial which can be used in place of titanium. In addition, not all of the patients were screened with the same salts, as the Ti series has expanded over the last 10 years. TEST is an epicutaneous patch test indicated for use as an aid in the diagnosis of allergic contact dermatitis in persons 6 years of age and older whose history suggests sensitivity to one or more of the 35 substances included on the T.R.U.E. It was sometimes difficult, and often impossible, to retrospectively determine the relative influences of all these different factors; hence the high amount of partial relevance in our study. endstream endobj 21 0 obj <> endobj 22 0 obj <>stream This topic needs more study. In our study, it was, notably, the highest‐scoring Ti salt, with positive reactions in 17 subjects (7.9%). 0000005690 00000 n From our data, no patient‐specific characteristics can be identified that could explain this. H�\��j�0��~ 0 beoordelingen. According to our study of 212 suspected patients with metal allergy, the result of patch test showed the highest positive reaction toward Nickel (Ni) 25%, followed by Palladium (Pd) 24.4%, Chromium (Cr) 16.7%, Cobalt (Co) 15.9%.8Also, Frigerio et al9who performed patch tests on 100 patients who underwent first joint arthroplasty showed that the allergic rate was positive toward Ni 21%, Co 8%, Pd 3%, and … 0000046840 00000 n O�v%bo��T��>O�b��� n�r �C��� �n���e{ �VR�b�9��'��� l!~}��{�� �m�F�W�N>�c�����og��d�ߖ�s�(����i�����B^�!�0�����A�kJ?8cȠ�m��ȃ�M�03��ءs��������BS��݌��d,� A cause of implant failure? This is emphasized by the lack of studies in which a positive patch test result is supported by a positive in vitro test. Metals with extremely low rates of allergic patch-test … Therfore, no preferable concentration of Ti isopropoxide could be determined. Nickel and cobalt were the most frequent co‐reactants (both 19.2%). 0000006544 00000 n €29,00 Incl. Titanium is being increasingly used. However, the significance of a positive reaction to Ti(IV) oxalate hydrate remains debatable, and has to be extensively examined on a case‐by‐case basis. H�\��n�@E�|E/�E��� !K��H^�C���v�b@/��ӗe�A�9��M����}7���44�0�S׷S��� ��]�d�k�f��Z��K=&i\|�_�p���!�*���7��tw�v8��$�1�a���{��=Ǐp ��Vn�vm8�B���{} . This study confirms, in a large population, that TiO2 as a patch test preparation is of no value in clinical practice. In the group of patients suspected of having Ti allergy, an even higher frequency of 8.9% was observed. Nevertheless, positive reactions in the control group, in which sensitization to Ti is highly unlikely, highlight the possibility of false‐positive reactions. There are currently no reports in which a panel of Ti salts has been used on a large patch test population. 0000003672 00000 n The demographic characteristics of the patients are summarized in Tables 4 and 5. 0000001362 00000 n Patch Test. Although titanium (Ti) is a biocompatible metal, since the patient had a history of allergy to dental materials, before implantation a preventive test to check the patient's response to the Ti was carried out. A 2‐tailed Fisher's exact test was used, as appropriate, to compare proportions of positive reactions to the Ti compounds in patients suspected of having Ti allergy with those in patients in the control group. endstream endobj 25 0 obj <> endobj 26 0 obj <>stream Although it is considered to be a non‐allergenic material, allergic reactions to it have been reported. Therefore, from this study we conclude that, although the delayed positive reactions (mainly on D3) are in favour of a true allergic reaction, it cannot be confirmed whether Ti is a true sensitizer, whether the recorded positive results underestimate sensitization, or how the specific symptoms of a Ti sensitization are expressed. After obtaining approval from our institutional review board, we performed a retrospective chart review on patients who underwent patch testing with ≥1 Ti test salts at the Allergy Unit of the Department of Dermatology at the VU University Medical Centre between January 1, 2004 and January 1, 2017. 0000000016 00000 n In conclusion, the frequency of Ti sensitivity in our patch test population was 5.7%. 0000004631 00000 n This may be explained by the small sample size of the control group and the relatively low numbers of positive reactions within both groups. 0000004371 00000 n Although it is considered to be a non‐allergenic material, allergic reactions to it have been reported. However, the difference in frequency of positive Ti oxalate reactions between patients suspected of having Ti allergy and the control group was non‐significant (P = .74). 0000003561 00000 n Although partial relevance was identified, the role of Ti hypersensitivity can be considered to be insignificant in this case. Titanium is biotolerant, het zou geen allergie moeten veroorzaken, maar er zijn altijd uitzonderingen blijkt in de praktijk.Metaalallergie blijft een optie. Metals are important contact sensitizers: an experience from Lithuania, Stratum corneum is an effective barrier to TiO2 and ZnO nanoparticle percutaneous absorption, Effect of size of TiO2 nanoparticles embedded into stratum corneum on ultraviolet‐A and ultraviolet‐B sun‐blocking properties of the skin, Incidence of metal sensitivity in patients with total joint replacements, True photoallergy to sunscreens is rare despite popular belief, Prospective analysis of human leukocyte functional tests reveals metal sensitivity in patients with hip implant. However, a single Ti salt cannot be used as a patch test preparation, as patient‐specific responses occur to different salts, their accuracy in diagnosing Ti sensitization is mostly unknown, and determining the relevance of a positive result is still challenging. researchers believe that titanium allergy is complicated by the fact that patients may be reacting to impurities found in in titanium [4], for example nickel, chromium and cadmium. A study by Bernard et al found only negative results in 30 control subjects who were patch tested with Ti oxalate, including in atopics.23 The authors therefore considered irritancy to be unlikely. h�b```�l6��mB �ac`a�h`h� ��;����1�,�60�� �]��b�TNP�`J%�����U���A�A��.�� k]�X1�p�`��R��Ͱ���>���� &6�����2D.`:�Ա� �Ə�UM[��f�3������� ��H � k"+� 0000012894 00000 n Fifteen of the 26 (57.7%) had a proven Ti‐containing implant or reconstructive material. A retrospective chart review was conducted with 458 patients who underwent patch testing with at least 1 of 5 different titanium salts. Skin patch tests for each metal component were needed in these cases, but skin patch tests do not always reveal a metal allergy . Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. 49 0 obj <>stream All patients were tested with ≥1 Ti salts depending on the date of referral and the Ti salts used at that time (Table 1). Objectives: To evaluate alternatives for titanium dioxide as a patch test preparation, and to profile titanium reactions and manifestations. In groups 2 and 3, 2 patients showed positive reactions (1.2% and 4.3%, respectively) (Table 3). Arguably, this may not be the case when it is dissolved in petrolatum. They cite an under-reporting of dental implant-related titanium-hypersensitivity by the profession as the reason for this. But while skin patch tests are ideal for some types of allergies, they’re not very accurate for other, including titanium allergies. 0000014582 00000 n Use the link below to share a full-text version of this article with your friends and colleagues. Cases of an allergy to titanium described in the literature reflect the difficulty in the diagnosis of this allergy. These tests are known to have a diagnostic efficiency of 75% for metal allergy, and can therefore underdiagnose a titanium sensitization or allergy. Few studies to date have profiled titanium allergy, and it therefore remains difficult to distinguish its manifestations. The present study shows that it is a superior salt for patch testing and can be of value in clinical practice. 0000002855 00000 n Titanium dioxide, also known as titanium(IV) oxide or titania, is the naturally occurring oxide of titanium, chemical formula TiO2. An allergen was considered to be clinically relevant if: (1) the existence of exposure could be established, and (2) the patient's complaints could be explained (completely or partially) with regard to that exposure. In 1 patient (no. >��>��ç�y�>����S��5 If you do not receive an email within 10 minutes, your email address may not be registered, Positive reactions rated as +, ++ or +++ in accordance with the ICDRG/ESCD reading criteria were regarded as allergic,14 whereas doubtful reactions (?+) were not. A Patch Test–Positive Titanium Hypersensitivity Reaction Olsen, Keith C. MD, PhD; Barnes, Peter BA; Morton, Kristen BA; Norris, Patricia MD Author Information 19–21,47 To reverse this trend, the authors recommended that the initial assessment of implant patients should include patch testing for implant patients with a history of metal allergy. %%EOF However, the patch test reagent for titanium is not standardized yet. 0000008137 00000 n Although Ti is generally believed to be “hypo‐allergenic”, numerous articles have been published describing allergic reactions to Ti.5-7 The prevalence of Ti allergy is not known, but is estimated to be very low. This illustrates the problems that clinicians face in evaluating Ti allergy, indicating that large‐scale prospective studies are necessary to develop new patch test salts and improve alternative diagnostic tools such as the LTT. Titanium: the ultimate solution or an evolutionary step? In 16 (61.5%) patients, the test result had partial or full clinical relevance. For those with at least 1 positive patch test result, additional data were collected on sex, age, symptoms, implanted devices, clinical diagnoses, and relevance of the positive result. Although it can be expected that testing with the expanded Ti series will enhance the detection of relevant positive reactions, the accuracy of these test salts can be questioned. In group 1, 22 patients showed positive test reactions (8.9%). In both the literature and this study, Ti allergy typically occurred in implant patients suffering from postoperative complaints. The retrospective nature of this study makes it difficult to address these problems. The mean age of the positive subjects was 55.2 years (range 20‐80 years); 53.8% were female. Ongeveer 15% van de Nederlandse bevolking is allergisch voor metalen. No source of Ti contact could be determined, and the result was therefore of no relevance. Patch test chambers were removed from the backs of the patients after 48 hours of exposure, and readings were performed on day (D) 2, D3, and D7. of patch tests, while others use prick tests and/or blood tests. Any queries (other than missing content) should be directed to the corresponding author for the article. �8Z�o�����͝F{3$��{��T�FՊS!=e� However, our study is the first to test a panel of Ti salts on a large patch test population. We tested a highly selected population; therefore, the high frequency of Ti sensitization that we found cannot be extrapolated to the general population. It may be interpreted as being attributable to false‐positive reactions to either of the materials. The test materials used were TiO2, Ti(IV) oxalate hydrate, Ti(IV) isopropoxide, Ti lactate, and Ti citrate. title = "A retrospective study on titanium sensitivity: Patch test materials and manifestations", keywords = "contact allergy, dermatitis, implants, medical device, patch test, titanium", We performed a retrospective study on all patients patch tested with Ti salts in our hospital. Metals causing no allergic patch-test reactions were titanium, Vitallium, and aluminum powder. To evaluate alternatives for titanium dioxide as a patch test preparation, and to profile titanium reactions and manifestations. Few studies to date have profiled titanium allergy, and it therefore remains difficult to distinguish its manifestations.

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